Counselling Survey
This survey could be adapted to suit different patient needs. This particular survey is aimed at patients who are supported at Oncology/Breast cancer units.
1
How did you find out about the counselling service offered by the Oncology/Breast cancer unit?
From a leaflet
From a member of staff involved in your care
Other
2
Once it was agreed that a referral to the counsellor would be helpful, how long was it before the counsellor contacted you?
0-7 days
7-14 days
3
Were you happy with the response time?
Yes
No
4
Did you feel that the counselling referral was made at the appropriate time for you?
5
Once your counselling started, how easy was it for you to make contact with the counsellor if you needed to?
Very Easy
Fairly Easy
Not Very Easy
Difficult
Very Difficult
6
Did you proceed with the counselling?
If you answered YES to Q6 then please answer these questions, otherwise thank you for your time.
7
How many sessions with the counsellor did you have?
One session
Two to five sessions
Six to ten sessions
8
Would you have liked more sessions?
9
Were you taught any relaxation Techniques?
10
If YES, did you find this a useful technique to help you manage your anxiety?
11
Were you taught other ways to manage stress?
12
If YES, were they helpful?
13
Would you find it helpful to be offered complementary therapies, such as aromatherapy massage and reflexology?
14
Did you find the room in which the counselling session took place:
Comfortable?
Welcoming?
Offered privacy?
15
Please use this space to make any further comments on the room:
16
How would you rate the usefulness of seeing the counsellor?
Very helpful
Helpful
OK
Unhelpful
Very unhelpful
17
In what ways have you found the counselling helpful or unhelpful?
18
Please use this space to elaborate on your answers or to make any further comments;
Thank you for providing your feedback.